Thursday, 21 April 2011

Most liberal-thinking people regard it as a given that we should respect and tolerate the beliefs of others, even if we don’t share them. However, this can land us in difficulties if the people who hold those beliefs don’t reciprocate. This seems to me at the heart of the debate on the burqa ban.

I vividly remember the time when Salman Rushdie was receiving death threats because of the publication of the Satanic Verses. I had fully anticipated that public figures in the UK would rally around him with robust support for freedom of speech. In fact, the support was muted. Although in part this was because of fear - as noted by Christopher Hitchens, - there were others who clearly felt a tension between such support and a need to empathise with the offence caused by the book. Roy Hattersley, for instance, recommended against publication of a paperback version of the book. And the Chief Rabbi wrote to The Times (4 March 1989) that 'the book should not have been published' because of the need to respect and 'generate respect' for other people's religious beliefs. Subsequently, when Rushdie was offered a knighthood, it was that staunch liberal, Shirley Williams, who emphasised the offence to Muslims, leaving it to Christopher Hitchens and the right-wing Boris Johnston to defend freedom of speech. So an asymmetric relationship was validated: I can’t criticise you because it might offend you, but you can not only criticise what I say, but also insist that I don’t say it at all, on pain of death.

Ayaan Hirsi Ali emphasised a similar trend in her memoir Infidel: liberals, she argued, were reluctant to take action against practices such as forced marriages and genital mutilation, because they did not like to be seen to be criticising another culture. Never mind that the culture was inflicting physical and mental damage on its women. This kind of logic was taken to an extreme by Germaine Greer, who argued that attempts to outlaw genital mutilation were an ‘attack on cultural identity’.

My own views on the matter are quite simple. I will tolerate the views of others so long as they tolerate me. I will respect their cultural identity so long as it does not discriminate against others on the basis of sex, ethnicity, or sexual identity. But I expect my cultural identity and beliefs to be correspondingly respected.

So where does that leave the burqa?

Some liberals adopt the easy argument and say that the burqa is a symbol of oppression, and should therefore be banned. There’s no doubt that the burqa has been used to oppress women, most notably by the Taliban. But it is an oversimplification to argue that all women who wear a burqa are oppressed. There are some (including the young Ayaan Ali Hirsi) who choose to wear it. Yes, that choice is bound to be influenced by the attitudes of those around her, but that is equally true of any woman’s choice of attire, whether it be stiletto heels and a mini-skirt or an all-encompassing robe.

So if it comes down to a woman’s right to choose what to wear, what’s the problem? The issue was mocked on Radio 4’s News Quiz last week, as the participants called for bans on other offensive items of clothing, such as socks with sandals or culottes. Andy Hamilton described the French attitude as: “We will force them to be liberated and if they refuse we will put them in prison”.

But the burqa is different from other clothing choices in two important ways. First, it interferes with communication. Liberal-minded people in the UK have no problem with others wearing symbols of their religion such as a turban or headscarf. The real problem is that in face-to-face interactions, wearing a burqa is at best discourteous, and at worst threatening. It creates an unequal relationship, when you can’t even verify the identity of the person you are interacting with, let alone read facial cues. There’s a vast literature in social psychology looking at how nonverbal cues are important in interpersonal communication (e.g. Knapp & Hall, 2009) . We use them to judge another person’s attitude, honesty, boredom and engagement, for a start. If one person has access to these cues and the other does not, that creates an asymmetry in the interaction. Just as British people must learn to respect the culture of others by not wearing skimpy clothing in Arab countries, Islamic women should respect cultural expectations that it is important to see the face of someone we interact with in person.

The second problem with the burqa is the rationale behind its adoption. As many in the Islamic community have emphasised, the burqa is not mandatory attire for a religious woman. However, Islamic women are required to dress modestly, and some interpret this as requiring total cover-up. I suspect that for some women this is an extreme reaction to our highly-sexualised Western society. But what message does the burqa give to men? I think it is offensive insofar as it implies that they are sexual predators whose lust may be inflamed by the sight of a woman’s face. I liked the response from a participant at the UN Human Rights Council, who suggested that rather than expecting women to cover up, men should stay indoors until they learned some self-control.

So if a woman is to wear a burqa, she should be aware of the impact on others: her choice will appear discourteous to many people, especially men. Qanta Ahmed, who describes herself as a moderate Muslim, makes a related point, noting that, far from giving an impression of modesty, part of that impact is to draw attention to oneself, make others feel threatened and increase hostility to Islam.

I don’t agree with Ahmed that the burqa should be banned; this will simply increase intolerance on both sides. I’m pleased that the British government is showing no signs of going down the same route as the French. Nevertheless, while I don’t think this is an issue that should be dealt with by law, I do think it is reasonable to exert social pressure. A woman has a right to cover up if she wishes, but she should be aware that this is regarded as culturally inappropriate in many situations in Western society. Employers have a right to expect their staff to have a sense of what is appropriate dress for a job; in many situations, a burqa is no more appropriate than hot pants or a crop top.

So in sum, I would defend the right of a woman to wear a burqa if she chooses. But I would also defend the right of someone like MP Philip Hollobone to refuse to meet with a constituent unless she reveal her face, and for an employer to require more appropriate clothing for someone interacting with the public. To do otherwise is to treat the burqa-wearing woman as someone who has rights but no responsibilities.

Wednesday, 13 April 2011

Results from psychological tests can be expressed in various ways. Percentiles are a popular format in clinical reports, because they can be explained to non-experts fairly easily, in terms of the percentage of the population that would be expected to get a score of this level or below. So if your score is at the 10th percentile, only 10% of the population would be expected to score this low.

The other format that is commonly used in reporting test scores is the standard score or scaled score. This represents how many standard deviations a score is above or below the population mean. The simplest version is the z-score, obtained by the formula:

(X-M)/S

where X is the obtained score, M is population mean, and S is the population standard deviation.

In clinical tests, z-scores are often transformed to a different scale, e.g. mean of 100 and SD 15 in the case of most IQ tests. This is done just by multiplying the z-score by the SD and adding the new mean. So a z-score of -.33 becomes a scaled score of (-.33 x 15)+100 = 95.

The important point to note is that all of these different methods of reporting scores are just transformations of one another. If you want to turn a z-score into a percentile, you can do so with the Excel function:

100*NORMDIST(A1,0,1,1)

where A1 is the address of the value you want to convert.

The second value in this expression is the mean and the third is the SD, so if you want to convert a scaled score with mean 100 and SD 15 into a percentile, the function is:

100*NORMDIST(A1,100,5,1)

The normsdist function returns a cumulative proportion, so it’s multiplied by 100 to give a percentage.

You can work the other way round using the NORMSINV function, which turns a proportion into a z-score. So if you have a percentile in cell A1, then you get a z-score with:

=NORMSINV(A1/100)

If all this Excel stuff gives you a headache, you can ignore it, so long as you get the message that z-scores, scaled scores and percentiles are all different ways of representing the same information.

They are NOT equivalent, however, in their distributions. Percentiles aren’t suitable as input to statistical procedures that assume normality, such as Anova and t-tests. They should always be converted to z-scores or other scaled scores.

This can be simply illustrated. If you are into Excel, you can generate your own data to make the point - otherwise you can just look at the output from the data I have generated.

Let’s simulate data from two groups, each of 50 participants. Assume the data are reading test scores, and that group 1 has reading difficulties and group 0 hasn’t. For group 0 I will just generate a random normal distribution of scores with mean 0 and SD 1, by typing this function in each of 50 cells:

=NORMSINV(RAND())

For group 1, I use the same formula, but subtract 0.4 from each score:

=NORMSINV(RAND())-0.4

I pasted my simulated data into SPSS, as it makes it a bit easier to generate relevant statistical output. So for each of 100 simulated subjects, I have a column denoting their group (0 or 1), a column with their z-score, and a column with their percentile score.

Here’s what you get if you do a t-test (you’ll get different values if you generated your own data as the random process is different each time - but it should show the same pattern):

So why, if the numbers are just transforms of each other, are the results different?

The answer lies in the distribution of data. If you take percentiles, you transform a normal distribution into a rectangular one, as can be seen if you plot the histograms.

(That hole in the middle of the percentile distribution is just a fluke in the particular dataset I generated). Another way to think about it is to consider the size of difference between two points in the distribution. In terms of z-scores, the difference between the 1st and 10th percentile is 2.32-1.28 = 1.04, and the difference between the 41st and 50th percentile is .23. But on the percentile scale, these differences are treated as equivalent. In effect, the percentile transformation stretches out the points in the middle of the scale and gives them more weight than they should have.

So percentiles are a good way of communicating test scores of individuals, but a bad choice if you are doing statistical analyses of group data.

Saturday, 9 April 2011

Many children with disabilities in the UK are not getting the help they need. The campaigning group Whizz-Kidz states: “There are around 70,000 disabled children in the UK who are waiting to get the wheelchair that suits them best. They can wait months, sometimes years”. And the situation for children with speech, language and communication needs is equally stark. According to the Bercow report, “The current system is characterised by high variability and a lack of equity. (It) is routinely described by families as a 'postcode lottery', particularly in the context of their access to speech and language therapy.”

A recent Green Paper on Special Educational Needs (SEN) released by the Department of Education takes such concerns on board, stating:
“The reforms we set out in this Green Paper aim to provide families with confidence in, and greater control over, the services that they use and receive. For too many parents, their expectations that services will provide comprehensive packages of support that are tailored to the specific needs of their child and their family are not matched by their experiences, just as frontline professionals too often are hampered and frustrated by excessively bureaucratic processes and complex funding systems.and has a wide range of recommendations.” (point 29). This all sounds excellent, so what exactly is proposed?

The two examples given above, of provision of wheelchairs and speech and language therapy are given particular focus. Specifically, the recommendation is for “the option of a personal budget by 2014 for all families with children with a statement of SEN or a new Education, Health and Care Plan” (point 6). There is an emphasis on bringing together the different agencies that are concerned with children who have complex educational needs, so that educational, medical and social agencies work together. So far so good.

Delving deeper into the document, we find the more specific statement:
“2.41 We have consulted on the introduction of patient choice of any willing provider that meets NHS standards and price for most NHS-funded services by 2013-14. This is likely to apply to many community health services. It will give families choice, where appropriate, from a range of providers who are qualified to provide safe, high quality care and treatment, and select the one that best meets their needs. It will mean that good providers that offer innovative and responsive services are able to grow.”

Note the use of the word “patient” here; although the document talks about “educational, medical and social agencies” working together, the description of the personal budget appears to relate just to health needs.

Not surprisingly, then, the proposed solution has strong parallels with current policies on provision of healthcare, with a focus on outsourcing to private providers. The personal budget is specifically mentioned in relation to provision of such facilities as wheelchairs or speech and language therapy services, which are currently provided via the National Health Service. One can see that any policy that ensures that children get what they need in a timely fashion is to be welcomed, and there is ample evidence that the current system has not always provided this.

The key question, of course, is whether the personal budget will be adequate to give children what they need. All too often, governments have dressed up healthcare policies as providing more “choice”, when in fact they are designed to save money. It is inconceivable in the current economic climate that any extra money will be available for disability and SEN. So everything hinges on whether the personal budget will be sufficient to cover a child’s needs. No doubt the expectation is that competition between private providers will drive down costs so it will be possible to “do more with less”. I hope this works, but I'm not optimistic.

But what about the educational and social aspects of provision? I’m particularly interested in whether the “patient choice” model will be extended from the medical to the educational sphere. Here there is a potential problem. For medical provision, it is argued that NHS standards must be met. One would hope, then, that there will be vetos on spending the personal budget on such interventions as “acupuncture miracle cure” or stem cell treatment for cerebral palsy. But in the field of special education it’s not clear what standards would need to be met.

Evidence-based education is still in its infancy, and in mainstream education there are plenty of instances where government funds have been spent on educational programmes of dubious or unproven effectiveness. Ben Goldacre, in his book Bad Science, documented the way in which Brain Gym programmes were introduced in UK schools, despite being full of ludicrous pseudoscience. Charlie Brooker’s account of this is also worth a read. Though we may laugh at these educational initiatives, they provide a nice income stream for those who are marketing them. (See also, http://wordpress.mrreid.org/2009/06/01/learning-styles-are-nonsense/)

If the plan is to give families a personal budget to spend on special education, there will be plenty of companies who will see this as a fantastic business opportunity. Some may be providing beneficial services, but there is a real risk that commercial companies will be rewarded with government funds for interventions of dubious or unknown value. Suppose your child has severe reading difficulties, language comprehension problems, or autistic features, and the classroom teacher seems at a loss to know how to help. It is easy to envisage a situation where private companies could offer attractive-sounding interventions, in anticipation that the “personal budget” could be used to support these. There are already numerous cases of such fringe interventions, but currently any parent who wants to try them has to find their own funding. In most cases, the only evidence for efficacy is anecdotal. In a few, claims of scientific support are made, but usually when investigated, the evidence proves to be weak. Randomized controlled trials are very rare in the field of education, and where these have been applied to interventions for children’s learning and educational difficulties, results have typically been much less impressive than when uncontrolled studies are done.

Clearly, if we demanded that any educational approach used in schools had to be demonstrated to be effective to a high standard of evidence, the school system would grind to a halt. Education has never been required to meet the standards of evidence seen in medicine. Furthermore, no innovations would ever occur. I’m a great fan of changing this system to one of “evidence-based education”, but I am realistic enough to realise it is not going to happen overnight. And if we do take an evidence-based approach, we need to consider carefully the way in which we measure children’s outcomes: it could be a mistake to have a narrow focus on educational attainment that does not consider other aspects of well-being. But we need to address these issues urgently if we are going to give “any willing provider” the opportunity to sell services for children with special needs.

As an example of the potential pitfalls, it is worth reading a 2008 report of the Enterprise and Learning Committee of the Welsh Assembly It is noteworthy that some of those advising the committee had vested interests in the programmes under discussion: Prof David Reynolds had financial interests in the Dore programme, and evidence for efficacy of FastForword was provided by those who sold the programme, and a professor whose institution had made $5.5 million from royalties. The committee were apparently unaware of independent evaluations of these programmes that gave a much less positive picture, see: http://tinyurl.com/3q4jen9 and a recent meta-analysis of FastForword, which includes studies published prior to 2008 (not to be confused with the Fast Forward wheelchair campaign).

I am not saying that private companies should be excluded from providing special education. Potentially, they have much to offer: being freed from bureaucracy of state-based organisations they have potential to develop new approaches, or to deliver traditional services in an exemplary fashion. But we need to have stringent standards in place when evaluating “willing providers” and ensure there is no conflict of interest in those advising on appropriate interventions. Some providers will see this population as a wonderful commercial opportunity. We need to ensure that limited funds are spent wisely and well.

Of course, this is only germane if a personal budget will be available for educational as well as medical interventions. I wonder whether it will be. The Green Paper is not clear on this, noting merely that “Subject to piloting, this would include funding for education and health support as well as social care”. But even if the piloting supports educational uses for a personal budget, it is not clear which children would have access to this. On the one hand, the Green Paper emphasises the numerous ways in which children currently identified with SEN have poor outcomes. Yet on the other hand it seems to imply that many of those with labels of SEN don’t have genuine problems: “Previous measures of school performance created perverse incentives to over-identify children as having SEN. There is compelling evidence that these labels of SEN have perpetuated a culture of low expectations and have not led to the right support being put in place.” (point 22). And “we intend to tackle the practice of over-identification by replacing the current SEN identification levels of School Action and School Action Plus with a new single school-based SEN category for children whose needs exceed what is normally available in schools; revising statutory guidance on SEN identification to make it clearer for professionals; and supporting the best schools to share their practices." (point 24, my emphasis). Finally, “A new single early years setting- and school-based category of SEN will build on our fundamental reforms to education which place sharper accountability on schools to make sure that every child fulfils his or her potential.” (point 5, my emphasis).

The Green Paper sounds full of good intentions, but I’m cynical. Cutting through the fine language I see a pincer movement to cut costs of children with disabilities and SEN: first, by radically reducing the number of children who will be deemed to need special provisions, and second, by passing responsibility for the remainder over to the marketplace. I fervently hope the recommendations will do good in overcoming the obstacles currently faced by families in obtaining necessary equipment and services, but I have two worries. First, that the profit motive of those in the marketplace might conflict with the child’s best interests, and second that the net impact for children with hidden disabilities will be to reduce provision and then blame teachers for children’s educational failure.

The Green Paper is a consultation document; I'd encourage all readers with an interest in this area to read the document and give your own views: you have until 30th June 2011 to respond.